الفهرس 
PEDIATRIC SEPSISOnly 14 pages are availabe for public view
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Abstract
Background: Multiple organ failure (MOF) is still a common cause of death in ICU despite the efforts to prevent this ultimate evolution of critical illness. Among the different mechanisms involved in the complex pathophysiology of MOF, injury to the gut may play a key role. The gut mucosa constitutes a barrier protecting the internal milieu from the intraluminal content. Since any insult to the barrier results in increased permeability to large molecules, it has been hypothesized that bacteria or bacterial products such as endotoxin, could be ”translocated” into the blood stream, subsequently promoting systemic inflammatory responses and development of MOF. Lactic acid, like many organic molecules, consists of two mirror-image isomers. L-lactate is produced by the human body and is the isomer tested for in common “lactate” assays. D-lactate, the mirror image of L-lactate, is produced in minute concentrations in human
Objective: To test effect of lactoferrin supplementation for improving gut barrier function, prognosis and the outcome of septic patients using d lactate as a marker of bacterial translocation in patients with sepsis and gut failure.
Patients and Methods: The present study was double armed single blinded therapeutic clinical trial conducted on 50 children who were admitted to the PICUs of Ain Shams University Hospitals with diagnosis of sepsis with acute gut failure, their ages ranged from 1month -18 years. They were 26 males and 24 females. The cases were randomly divided into 3 groups: group (1): 20 patients: septic patient with gut failure not receiving lactoferrin; group (2): 20 patients: septic patient with gut failure receiving lactoferrin; group (3): 10 patients: control group of clinically healthy age and sex matched children.
Results: There was highly significant difference (P –value 0.008) between Patient and control group in D lactate level. Regarding hematological, biochemical,, SOFA,GIF score between discharged and died patient our study reported that; show no statistical difference between both group Except SOFA score which higher in died with p-value 0.007and also GIF score higher in died with p value.005. On our Result of lab and SOFA,GIFE score of all patient before giving lactoferrin and after giving it; we found that no statistical difference between SOFA score, GIF score laboratory result before giving lactoferrin and after it either creatinine BUN,level where there is statistical difference in creatinie and SOFA score. Regarding ROC curve show that the best cut of point for sofa score to detect mortality was found>7 with sensitivity 50% and specificity 100% while for D lactate after receiving lactoferrin was found cut of point 43.9 senstivity55%and specificity 85%.
Conclusion: The serum level of Dlactate there is statistical difference between both septic PICU patient presenting with gut failure and control group so D lactate.can be used as marker to detect early intestinal wall damage taking into consideration number of sample and time of sampling SOFA score is agood predictor of mortality and gives more predidction if combined with GIFE score and Dlacte as predictor of mortality. Lactoferrin administration has no statistical difference on our study on PICU patient may related to sample size or duration of administering